Podcast 113- DON'T stop the insulin!

We realized the other day that we have yet to do a podcast on diabetic ketoacidosis (DKA). In this episode, we spend a little bit of time talking about the pathophysiology, but the majority is focused on the logistics of running a DKA transfer. Here are the highlights:   DO EVERYTHING YOU CAN TO AVOID STOPPING THE INSULIN.   DO EVERYTHING YOU CAN TO AVOID STOPPING THE INSULIN.   DO EVERYTHING YOU CAN TO AVOID STOPPING THE INSULIN.   The way you do this safely is by pre-planning! Ask for these things before you leave the hospital:  

1. IV Potassium
2. Liter bag of D5W
3. Bag of lactated ringers
4. Three amps of sodium bicarbonate (if renal failure is suspected)

If I add weak acids (ketones) into the anion side, the body will dump bicarbonate to maintain electrical neutrality. The only way to get the bicarbonate to return to normal is to get rid of the ketones.   I got rid of all my ketones but my bicarb has not returned to normal!! Why?!

1. You gave too much chloride which is now hogging all the anion space.
2. The kidneys aren't working properly and you need to give sodium bicarbonate.